Bleeding hemorrhoids: when to see a doctor

Bright red blood on the toilet paper or in the bowl after a bowel movement is the most common sign of bleeding hemorrhoids, and it is usually light and painless. Get help today if the bleeding is heavy, will not stop, comes with clots, or makes you feel faint. Even if it is light, have it checked by a doctor at least once, because other conditions can bleed in the same way (NIDDK).

Hemorrhoids (spelled haemorrhoids in the UK, and often called piles) are swollen blood vessels in and around the back passage. This guide explains what the blood you see may mean, how to help it settle, and exactly when to see a doctor.

Why hemorrhoids bleed

Internal hemorrhoids sit inside the rectum, the last part of the bowel. Hard stools and straining put pressure on them, and they can bleed. That is why the blood usually appears right after a bowel movement: on the paper, on the outside of the stool, or as drops in the bowl (NIDDK).

Internal hemorrhoids that stay inside are usually not painful. Many people have no other symptom than the blood. External hemorrhoids, under the skin at the edge of the opening, are more often itchy or sore and bleed only occasionally (Cleveland Clinic). If you are not sure which kind you have, see internal vs external hemorrhoids.

Blood when wiping: is it hemorrhoids?

Often, yes. Hemorrhoids are the most common cause of anal symptoms. But not every bleed is a hemorrhoid. Bleeding from the rectum can also be a sign of Crohn’s disease, ulcerative colitis or cancer of the colon or rectum (NIDDK).

Other common causes of bright red blood include (NHS):

• An anal fissure, a small tear in the skin of the opening. It usually causes a sharp pain when you go and a burning pain afterwards that can last for hours (NHS). Painless bleeding points more towards internal hemorrhoids.
• Blood-thinning medicines, such as warfarin, apixaban or aspirin, which can make bleeding more likely.
• Sexually transmitted infections, or damage from anal sex.
• Broken blood vessels in the gut (angiodysplasia).

You cannot tell these apart reliably on your own. That is the main reason a first check with a doctor matters.

What the color of the blood may mean

The color and where you see the blood give useful clues. Bright red usually means the bleeding is near the bottom end of the bowel. Dark or black blood is more likely to come from higher up, such as the stomach (NHS).

Red or purple foods such as beetroot and tomatoes can make stool look as if it contains blood (NHS). If you are not sure, treat it as blood and ask.

How much bleeding from hemorrhoids is normal?

No amount of bleeding is something to ignore, but hemorrhoid bleeding is usually small. Typical signs are a smear on the paper, red streaks on the stool or pink water in the bowl. The NHS says a small amount of one-off bleeding is not usually a serious problem and can often go away on its own (NHS).

What is not typical:

• The toilet water turning red
• Large blood clots
• Bleeding that keeps going after you have finished
• Feeling faint, dizzy, short of breath or very tired

Any of these needs care today (see below).

Slow, repeated bleeding can matter too, even when each episode is small. Over time it can lower your red blood cell count, called anemia, which can make you feel weak and tired. A simple blood test can pick this up (American Cancer Society).

How to stop hemorrhoid bleeding

Most bleeding settles when the swollen vessels stop being scraped and squeezed. The goal is soft stools that pass without pushing (NHS; NIDDK).

Make stools soft

• Eat more fiber. Oats, beans, lentils, fruit, vegetables and wholegrain bread all help. Increase slowly to avoid bloating.
• Consider a fiber supplement such as psyllium, with a full glass of water. A pharmacist can suggest a gentle laxative if you are constipated.
• Drink plenty of fluids. Fiber only softens stool when there is enough water with it.
• Cut down on alcohol and caffeine, which can add to constipation.

Change toilet habits

• Go when you feel the urge. Holding it in makes stool harder.
• Do not strain or push hard.
• Do not sit on the toilet longer than you need to. Leave your phone outside.

Be gentle with the area

• Pat the area clean and dry. Do not rub with dry paper.
• A warm bath, or a shallow warm sitz bath, can ease pain and itching. See how to take a sitz bath.
• An ice pack wrapped in a towel can ease discomfort.

Be careful with medicines

• The NHS advises not taking ibuprofen while hemorrhoids are bleeding. Paracetamol (acetaminophen) is the usual choice for pain. Avoid painkillers that contain codeine, as they cause constipation (NHS).
• Pharmacy hemorrhoid creams and suppositories can ease soreness, swelling and itching. Doctors usually recommend them for about 1 week. See a doctor if they have not helped after a week or cause a rash or dry skin (NIDDK).
• If you take a blood thinner, do not stop it on your own. Tell the doctor who prescribes it about the bleeding.

It can help to note each day whether you bled and what your stool was like. The Sitwell app lets you log this alongside your habits, which makes patterns easier to see and to describe to a doctor.

When home care is not enough

With smaller hemorrhoids, pain and bleeding may last a week or slightly longer (Cleveland Clinic). If bleeding keeps coming back despite good habits, a doctor can treat bleeding internal hemorrhoids in the clinic. The most common option is rubber band ligation: a small band is placed around the base of the hemorrhoid to cut off its blood supply, and it shrivels and falls off, usually within a week. Other options include sclerotherapy (an injection), infrared coagulation and electrocoagulation (NIDDK). You are usually awake for these and go home the same day (NHS).

For typical timelines, see how long do hemorrhoids last.

Hemorrhoids or colon cancer: is it something serious?

This is the worry behind many searches, and it is a fair one. Colorectal cancer can cause rectal bleeding with bright red blood, just like hemorrhoids (American Cancer Society). So the color of the blood cannot rule cancer out.

The reassuring part: many of these symptoms are caused by other conditions, including hemorrhoids, infection or irritable bowel syndrome (American Cancer Society). The NHS says bowel cancer is easier to treat if it is found early, which is why it is worth getting bleeding checked rather than guessing (NHS).

Signs that make a check more important (NHS; American Cancer Society):

• A change in your bowel habit that is not usual for you: looser stools, constipation, or going more or less often
• Stools that are thinner than normal
• Blood that is dark, or mixed into the stool
• Often feeling you need to go, even right after going
• Stomach pain, a lump in your belly, or bloating
• Losing weight without trying, or feeling unusually tired

Age and family history matter too. The American Cancer Society recommends that people at average risk start regular colorectal cancer screening at age 45, and people with a strong family history may need to start earlier (American Cancer Society). If you are over 45 or bowel cancer runs in your family, do not assume bleeding is hemorrhoids until a doctor has examined you.

When to see a doctor

Even if your bleeding is light and you feel well, see a doctor about rectal bleeding at least once (NIDDK). Also see a doctor if you still have symptoms after a week of home care, or they keep coming back.

Get medical help today if you have:

• Heavy bleeding that does not stop, or you are passing blood clots
• Feeling faint, dizzy or short of breath along with bleeding
• Severe pain with a fever, or a lump that is quickly getting bigger, darker or harder

Go to an emergency department or urgent care. Call your local emergency number if you feel faint or the bleeding is heavy, and do not drive yourself (NHS).

Book a doctor visit if you have:

• Black or tar-like stools, or dark blood mixed into the stool
• Weight loss without trying, or unusual tiredness
• A change in bowel habit lasting more than 3 weeks (looser, more often, or new constipation)
• Bleeding that no doctor has examined, and you are over 45 or have bowel cancer in the family

These are usually harmless, but they should be checked before you assume the cause is hemorrhoids. Do not wait long. For black or dark red stools, or bloody diarrhea, the NHS advises asking for an urgent appointment or calling NHS 111 (NHS). It also advises an urgent appointment if you have hemorrhoids and painless bleeding, a high temperature, or pus leaking from them (NHS).

Bleeding during pregnancy or after giving birth deserves a word with your midwife or doctor. See hemorrhoids during pregnancy and after birth.

What the doctor will do

Many people put off the appointment because they feel embarrassed. Doctors see this every day, and the visit is usually short.

Questions about your symptoms

Your doctor will ask about your symptoms, eating and toilet habits, any laxative or enema use, and other health conditions (NIDDK). It helps to bring a few notes:

• What the blood looks like and where you see it
• How often it happens and when it started
• Any change in your bowel habit, weight or energy
• Medicines you take, especially blood thinners and iron
• Any family history of bowel cancer

The examination

The doctor will look at the skin around the opening for lumps, swelling, skin tags or a fissure (NIDDK). They will usually do a digital rectal exam: with a gloved, lubricated finger, they gently feel inside the back passage for tenderness, blood, hemorrhoids or lumps. You lie on your side with your knees drawn up, or lean over the exam table. It takes a few minutes and is usually painless, though it can feel a little uncomfortable (Cleveland Clinic).

A look inside

To see internal hemorrhoids clearly, the doctor may look inside with a short tube and a light:

• Anoscopy looks at the lining of the anus and lower rectum. It is done in the office, and most people do not need anesthesia (NIDDK).
• Sigmoidoscopy looks a little further, into the lower part of the colon (Cleveland Clinic).

The doctor may also ask for a stool sample, or refer you to a specialist for more tests (NHS).

If you are referred for a colonoscopy

A colonoscopy checks the whole large bowel with a thin tube that has a small camera. It is a common test for bleeding from the bottom or blood in the stool. You take laxatives beforehand to empty the bowel. The test itself usually takes 30 to 45 minutes, and you can be offered painkillers, sedation or gas and air (NHS). Being referred does not mean the doctor thinks you have cancer. It is how they make sure.

Once the cause is clear, you can treat it with confidence. If it is hemorrhoids, that usually means the home care above, and an office procedure such as banding if bleeding continues.